In Reply We thank Drs Mark and Vinson for their sensible comments regarding our research1 and its implications. The experimental pathway incorporated a 2-hour accelerated diagnostic protocol, but some sort of secondary testing (usually exercise stress test) was also fundamental to the pathway unless clearly not indicated (eg, recent testing was already performed). The experimental pathway is now the standard of care in our hospital and still incorporates follow-up testing. There are no plans to remove this because after ruling out acute myocardial infarction there is still the possibility that a patient may have significant coronary artery disease and unstable angina. As demonstrated by the Global Registry of Acute Coronary Events study,2 unstable angina (even when treated) carries a significant onward mortality risk.
Than M, Aldous S, Young J. Low-Risk Chest Pain in the Emergency Department—Reply. JAMA Intern Med. 2014;174(6):1010. doi:10.1001/jamainternmed.2014.914
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